Witness: Doctor caused death of Michael Jackson

Dr. Conrad Murray, center, looks on beside his lawyers J. Michael Flanagan, left, and Nareg Gourjian during Murray's involuntary manslaughter trial, Wednesday, Oct. 19, 2011, in downtown Los Angeles. Murray has pleaded not guilty and faces four years in prison and the loss of his medical license if convicted of involuntary manslaughter in Michael Jackson's death. (AP Photo/Reed Saxon, Pool)

LOS ANGELES (AP) – A medical expert testified Wednesday that a physician’s repeated and flagrant violations of the standard of care involving a powerful anesthetic led to the death of Michael Jackson.

Dr. Steven Shafer told jurors the lack of proper medical equipment and the absence of notes and medical records by Dr. Conrad Murray, along with a breakdown of the patient-doctor relationship were factors in the death.

Murray was acting more like Jackson’s employee than a physician who should have rejected the singer’s requests for the anesthetic propofol as a sleep aid, Shafer said.

“Saying yes is not what doctors do,” he testified. “A competent doctor would know you do not do this.”

The Columbia University professor and researcher gave jurors a crash course on propofol, the powerful anesthetic used in hospital settings that has been cited as Jackson’s cause of death.

A video shown to jurors detailed numerous safety measures that were not employed by Murray when he administered the drug to Jackson as a sleep aid at the singer’s home, according to testimony.

“The worst disasters occur in sedation and they occur when people cut corners,” Shafer said. In Jackson’s case, “virtually none of the safeguards were in place,” he added.

Shafer is expected to be the last prosecution witness in the involuntary manslaughter case against Murray.

He said the fact that Murray was on his cell phone in the hours before Jackson’s death was a setup for disaster.

“A patient who is about to die does not look all that different from a patient who is OK,” Shafer said, adding that doctors cannot multitask and properly monitor a patient who is sedated.

Shafer, who wrote the package insert that guides doctors in the use of the anesthetic, lectured the panel as if they were in a classroom. He narrated while the silent video took jurors into an operating room to see the specialized equipment and procedures.

The researcher told jurors that it appeared Murray intended to give Jackson large doses of propofol on a nightly basis. He said records showed Murray purchased 130 100ml vials of propofol in the nearly three months before Jackson’s death.

Shafer said that is “an extraordinary amount to purchase to administer to a single individual.”

He also told jurors that keeping records is essentially.

While narrating the video, Shafer noted the doctor in the footage was taking copious notes.

“Moment by moment, the anesthesiologist writes down everything that happens, as diligently as you are doing here,” he said as jurors scribbled in notebooks.

He said the lack of record-keeping was an unconscionable violation of Jackson’s rights, especially if something went wrong.

“He has a right to know what was done to him,” Shafer said. “With no medical record, the family has been denied that right.”

Testimony has shown that Murray took no notes on his treatment of Jackson and didn’t record his vital signs on June 25, 2009, the day Jackson died.

“The record is not just some static document,” Shafer said. “It’s fundamental to the care that is given.”

He also said Jackson should have signed a written informed consent form to show he knew the danger of his treatment.

“Verbal informed consent is not recognized,” he said. “It does not exist.”

Shafer said he was testifying for the prosecution without a fee because he wants to restore public confidence in doctors who use propofol, which he called a wonderful drug when properly administered.

“I am asked every day in the operating room, ‘Are you going to give me the drug that killed Michael Jackson,’” Shafer said. “This is a fear that patients do not need to have.”

He said he has not charged for testifying in recent years because “there’s a personal thing about not profiting from a medical misadventure” and he doesn’t want to be accused of compromising his integrity.

Shafer, who edits journals on anesthesia and is widely published on the subject, gave jurors a demonstration from the witness stand of how propofol is drawn into an IV bag with a large syringe. He produced a bottle of the white substance that Jackson referred to as his “milk” and showed the steps involved, which took several minutes.

The explanation by Shafer and the depiction in the video seemed to belie an early defense claim that Jackson could have administered the drug to himself. The process shown Wednesday appeared too complicated for self-administration.

The video also suggested the only place for propofol to be administered properly is in a hospital with medical personnel on hand. The video showed a printed warning if problems arise: “Call for Help!”

“You have to respond instantly,” said Shafer. “If there is a problem you call for help before you treat because you’re going to need it.”

Murray, who has pleaded not guilty to involuntary manslaughter, told police he delayed calling 911 because he was giving Jackson CPR.

Murray has acknowledged giving Jackson doses of propofol in the superstar’s bedroom as a sleep aid. However, his attorneys have said the amount of propofol given to Jackson on the day he died was too small to cause his sudden death at age 50.

Chief defense lawyer Ed Chernoff objected to showing the video, but Superior Court Judge Michael Pastor said it was relevant. He ordered a few segments excised by Deputy District Attorney David Walgren before he presented it.

Murray’s attorneys will begin calling witnesses Friday. They plan to call 15 people, including police detectives, character witnesses and Randy Phillips, the head of AEG Live, the promoter of Jackson’s planned series of comeback concerts.

Chernoff said the defense should rest its case by Wednesday.

Murray’s attorneys are also going to call one of Shafer’s colleagues, Dr. Paul White, as an expert to try to counter the prosecution case.